A M Vintzileos1, C V Ananth, J C Smulian, D L Day-Salvatore, T Beazoglou, R A Knuppel. 1. Division of Maternal-Fetal Medicine, the Center for Perinatal Health Initiatives, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ, USA.
Abstract
OBJECTIVE: To compare the cost and benefits of prenatal diagnosis for Down syndrome using the British and American approaches. METHODS: This cost-benefit analysis was based on a decision-analytic approach. The British strategy included screening by a first-trimester ultrasound at 10-14 weeks for nuchal translucency thickness, and the American strategy included only second-trimester screening by using maternal age and maternal serum screening. The key probabilities of the decision-tree analysis and all cost estimates were based on American standards. The best scenario of the British strategy assumed ultrasound nuchal translucency thickness sensitivity (for detecting Down syndrome) of 80% and a false-positive rate of 5% and the worst scenario assumed a sensitivity of 50% and a false-positive rate of 10%. The results were expressed in annual costs based on approximately 4 million births per year in the United States. RESULTS: As compared with do-nothing, the American strategy was found to allow savings of approximately $96 million per year and the best scenario for the British strategy was savings of approximately $5 million per year. The financial costs of the British and American strategies would be comparable only if the first-trimester ultrasound had a sensitivity of 80% and a false-positive rate of 5% in detecting Down syndrome. CONCLUSION: The British strategy does not appear to be economically beneficial in the United States even under the most ideal scenarios of ultrasound accuracy.
OBJECTIVE: To compare the cost and benefits of prenatal diagnosis for Down syndrome using the British and American approaches. METHODS: This cost-benefit analysis was based on a decision-analytic approach. The British strategy included screening by a first-trimester ultrasound at 10-14 weeks for nuchal translucency thickness, and the American strategy included only second-trimester screening by using maternal age and maternal serum screening. The key probabilities of the decision-tree analysis and all cost estimates were based on American standards. The best scenario of the British strategy assumed ultrasound nuchal translucency thickness sensitivity (for detecting Down syndrome) of 80% and a false-positive rate of 5% and the worst scenario assumed a sensitivity of 50% and a false-positive rate of 10%. The results were expressed in annual costs based on approximately 4 million births per year in the United States. RESULTS: As compared with do-nothing, the American strategy was found to allow savings of approximately $96 million per year and the best scenario for the British strategy was savings of approximately $5 million per year. The financial costs of the British and American strategies would be comparable only if the first-trimester ultrasound had a sensitivity of 80% and a false-positive rate of 5% in detecting Down syndrome. CONCLUSION: The British strategy does not appear to be economically beneficial in the United States even under the most ideal scenarios of ultrasound accuracy.
Authors: Lusine Aghajanova; Jean M Popwell; Ryszard J Chetkowski; Christopher N Herndon Journal: J Assist Reprod Genet Date: 2015-07-03 Impact factor: 3.412